急性心肌梗死溶栓治疗与QTc离散度关系探讨

THE RELATIONSHIP BETWEEN QTC DISPERSION AND THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

目的观察溶栓治疗对急性心肌梗死(AMI)QTc离散度(QTcd)的影响及探讨QTcd与AMI并发室性心律失常的关系。方法选择接受静脉溶栓的AMI患者63例,分别测量溶栓成功组与失败组QTd,QTcd;并进行前后比较。同时对并发各型室性心律失常患者QTd,QTcd进行对照比较。结果63例接受静脉溶栓患者中,39例溶栓成功,24例溶栓失败。成功组治疗前后比较,QTd,QTcd明显减小(P<0.05);失败组治疗前后比较,QTd,QTcd增加(P<0.05)。溶栓治疗后共有34例患者发生室性心律失常,各型室性心律失常QTd,QTcd比较有非常显著统计学意义(P<0.01)。结论溶栓治疗成功,可使AMI后QTd、QTcd显著降低。QTcd越大,其发生室性心律失常,特别是致死性室性心律失常机会也越大。

OBJECTIVE:TO OBSERVE THE EFFECT OF QTC DISPERSION WITH THROMBOLYSIS AND TO DISCUSS THE RELATIONSHIP BETWEEN QTC DISPERSION AND VENTRICULAR ARRHYTHMIA IN ACUTE MYOCARDIAL INFARCTION (AMI). METHODS: SUCCEEDING GROUP AND FAILING GROUP WERE SEPARATED IN 63 CASES OF AMI ACCORDING TO THE EFFECT OF THROMBOLYSIS. QTD AND QTCD WERE MEASURED AND COMPARED IN TWO GROUPS BEFORE AND AFTER THROMBOLYSIS. QTD AND QTCD WERE COMPARED IN GROUPS WITH OR WITHOUT VENTRICULAR ARRHYTHMIA. RESULTS: QTD AND QTCD WERE SIGNIFICANTLY DECREASED AFTER THROMBOLYSIS COMPARED WITH BEFORE THROMBOLYSIS IN 39 CASES OF SUCCEEDING GROUP(P < 0.05) WHILE QTD AND QTCD WERE SIGNIFICANTLY INCREASED IN 24 CASES OF FAILING GROUP(P < 0.05). VENTRICULAR ARRHYTHMIA OCCURRED IN 34 CASES AFTER THROMBOLYSIS AND QTD AND QTCD WERE DIFFERENT IN DIFFERENT KINDS OF VENTRICULAR ARRHYTHMIA. CONCLUSION: QTD AND QTCD WILL BE SIGNIFICANTLY DECREASED IF SUCCEEDING IN THROMBOLYSIS IN AMI. THE OPPORTUNITY OF OCCURRENCE OF VENTRICULAR ARRHYTHMIA WILL INCREASE WITH THE LONGER QTCD, ESPECIALLY IN LETHAL VENTRICULAR ARRHYTHMIA.